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Fallopian Tube Procedures for Infertility

Surgery Overview

A
fallopian tube blockage typically prevents successful passage of the egg to the sperm, or the fertilized egg to the
uterus. Surgery can be used to try to correct this
common cause of
infertility. The specific type of surgery depends on
the location and extent of the fallopian tube blockage.

Some tubal procedures can be done using
microsurgical techniques, either during open abdominal surgery or using
laparoscopy through a small incision. The surgeon must
have special training and expertise in microsurgery techniques and/or
laparoscopy. This general overview describes the most common tubal
procedures.

Tubal reanastomosis typically
is used to reverse a
tubal ligation or to repair a portion of the fallopian
tube damaged by disease. The blocked or diseased portion of the tube is
removed, and the two healthy ends of the tube are then joined. This procedure
usually is done through an abdominal incision (laparotomy),
but some specialists can do this procedure using
laparoscopy.

Salpingectomy, or removal of part of a fallopian tube, is done
to improve
in vitro fertilization (IVF) success when a tube has
developed a buildup of fluid (hydrosalpinx). Hydrosalpinx makes it
half as likely that an IVF procedure will succeed.1
Salpingectomy is preferred over salpingostomy for treating a hydrosalpinx
before IVF.

Salpingostomy is done when the
end of the fallopian tube is blocked by a buildup of fluid (hydrosalpinx). This
procedure creates a new opening in the part of the tube closest to the ovary.
But it is common for scar tissue to regrow after a salpingostomy, reblocking
the tube.

Fimbrioplasty may be done when
the part of the tube closest to the ovary is partially blocked or has scar
tissue, preventing normal egg pickup. This procedure rebuilds the fringed ends
of the fallopian tube.

For a tubal blockage next to the uterus, a
nonsurgical procedure called selective tubal cannulation
is the first treatment of choice. Using
fluoroscopy or
hysteroscopy to guide the instruments, a doctor
inserts a catheter, or cannula, through the
cervix and the uterus and into the fallopian tube.

What To Expect After Surgery

After open abdominal surgery, there
usually is a 2- to 3-day hospital stay. Antibiotics may be given to prevent
infection. A woman usually can return to work in 4 to 6 weeks, depending on the
extent of surgery, the nature of her work, and her overall health and
stamina.

After laparoscopic surgery, there is a brief hospital
stay. A woman's return to daily activities can take a few days to a couple of
weeks, depending on the type of procedure.

Why It Is Done

How Well It Works

The success of a fallopian tube
procedure depends in part on the location and extent of the blockage, as well
as the presence or absence of other fertility problems.

Clearing a blockage in the part of the tube
closest to the uterus (proximal occlusion) is more likely to be successful.
These blockages often are functional (such as a mucus plug) rather than
structural (such as scarring or other obstruction). Up to 60 out of 100 women with
proximal occlusion have been reported to have successful pregnancies after
tubal surgery.2

From 20 to 30 out of 100 women
with a blockage near the end of the fallopian tube have had successful
pregnancies after tubal surgery.2

The
amount of fallopian tube that remains after surgery is critical to the function
of the tube. If a large part of the tube must be removed to eliminate blockage,
the likelihood of pregnancy after surgery is reduced.

The success of a
sterilization reversal is influenced by the tubal
ligation method used, by how recently the tubal ligation was done, and by
the woman's age-related fertility.

Other conditions that
affect the success of surgery include not only whether the woman has scar
tissue (adhesions) in her pelvis and whether she has other diseases in the
pelvic area but also the surgeon's level of skill and experience.

Risks

Risks of fallopian tube surgery include:

Pelvic infection.

Scar tissue
(adhesions) forming on the reproductive organs, causing them to bind to the
abdominal wall or to other organs.

What To Think About

Some fallopian tube problems can
be treated with more than one type of surgery or procedure. Ask your doctor for
his or her success rates (birth of a healthy baby), as well as national success
rates, for any procedure you are considering.

Hysterosalpingography may be done 3 to 6 months after surgery, to
check whether the tubes have been opened.

If you do not become
pregnant within 12 to 18 months following surgery, your doctor may do a
laparoscopy to check the condition of your fallopian tubes or may refer you for
in vitro fertilization (IVF).

When successful, a fallopian tube
procedure can enable a woman to have more than one pregnancy without ongoing
fertility treatment and repeated use of IVF.2

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